LAUSR

FIGURE 2: (A) Photomicrography showing multiple multinucleated giant cells (*), arranged along with inflammatory infiltrate composed primarily of epithelioid histiocytes and lymphocytes (Hematoxylin and eosin; original magnification ×400). (B) Photomicrography showing acid-fast bacillus (arrow) inside a multinucleated giant cell (Ziehl-Neelsen stain; original magnification ×1000). FIGURE 1: Initial clinical presentation of the ulcerative lesion affecting the apex of the tongue. A 36-year-old man presented with a chief complaint of a painful non-healing lesion on the tongue, with a development time of approximately 60 days. Physical examination revealed a poorly defined ulcerative lesion affecting the tongue apex (Figure 1). Lymphadenopathy was not observed. The patient reported previous use of triamcinolone acetonide for over 30 days without any improvement. Hematological examinations were within normal limits, and serological tests were negative for human immunodeficiency virus (HIV), syphilis, and hepatitis. An incisional biopsy was performed to assist with the diagnosis. Microscopically, the lesion showed granulomatous inflammation, composed of multinucleated giant cells, epithelioid histiocytes, and lymphocytes (Figure 2A). Ziehl-Neelsen staining was positive for acid-fast bacilli (Figure 2B), leading to the diagnosis of tuberculosis. Neither chest imaging alterations nor other signals of pulmonary or systemic involvement were observed. Sixty days after starting antituberculous therapy, the patient presented with complete healing of the oral lesion (Figure 3). After six months, no signs of relapse were observed.